Cost-effective interventions to control CVD and DM in South Asia
| Intervention | Comparator | Analytical time horizon | Incremental cost per capita (US$)* | Incremental effect (DALY averted/QALY gained)* | ICER, 2017† Cost-effectiveness threshold: <GDP per capita per QALY=green; 1–3×GDP per capita per QALY=yellow |
| Primordial prevention | |||||
| Policy interventions | |||||
| Tobacco control strategies (Ortegón et al 29) | Incremental DALYs averted per million population | ||||
| Increased taxation (60%) | No intervention | Lifetime | 0.27 | 3043 | 207 |
| Tax increase+advertisement ban | Increased taxation | Lifetime | 0.1 | 607.0 | 423 |
| Tax increase+clean indoor air law | Increased taxation | Lifetime | 0.09 | 574 | 366 |
| Tax increase+information/labelling | Tax increase+clean indoor air law | Lifetime | 0.11 | 485 | 529 |
| Tax increase+advertisement ban+clean indoor air law | Tax increase+clean indoor air law | Lifetime | 0.12 | 683 | 410 |
| Tax increase+advertisement ban+information/labelling | Tax increase+advertisement ban+clean indoor air law | Lifetime | 0.11 | 485 | 529 |
| Tax increase+clean indoor air law+advertisement ban+information and labelling | Tax increase+advertisement ban+clean indoor air law | Lifetime | 0.20 | 996.0 | 468 |
| Tobacco control strategies (Jha et al 60) | |||||
| 33% price increase—low-end effect estimate | No intervention | Lifetime | 5 | ||
| 33% price increase—high-end effect estimate | No intervention | Lifetime | 71 | ||
| Non-price interventions‡ effectiveness 2%–10%—low-end estimate | No intervention | Lifetime | 89 | ||
| Non-price interventions‡ effectiveness 2%–10%—high-end estimate | No intervention | Lifetime | 1132 | ||
| Complete smoking ban in public places (Donaldson et al 30) | Current legislation for partial smoking ban in public places | 10 years | −36 056 957 | 17 478 (acute myocardial infarction case averted) | 732 |
| School-based smoking prevention programme (Brown et al 31) | No intervention | 175 438.5 | 4.52 (QALY/smoker averted) | 4501 | |
| Promoting healthy diet strategies (Cecchini et al 32) | |||||
| Food labelling | No intervention | 20 years | 2220 | ||
| Fiscal measure for 100% population | No intervention | 50 years | Cost-saving | ||
| Food advertising regulation | No intervention | 50 years | 774 | ||
| Food labelling | No intervention | 50 years | 1810 | ||
| Promoting healthy diet strategies (Murray et al 57) | |||||
| Salt reduction through voluntary agreements with industry | No intervention | Lifetime | 106 | ||
| Population-wide reduction in salt intake legislation | No intervention | Lifetime | 54 | ||
| Health education through mass media | No intervention | Lifetime | 40 | ||
| Salt reduction via legislation+health education via mass media | No intervention | Lifetime | 49 | ||
| Promoting healthy diet strategies (Willett et al 5) | Lifetime | ||||
| Media campaign to reduce saturated fat content | No intervention | Lifetime | 5086 | ||
| Substitute 2% of energy from trans fat with polyunsaturated fatty acid (7% coronary artery disease reduction at $0.5 per adult) | No intervention | Lifetime | 104 | ||
| Substitute 2% of energy from trans fat with polyunsaturated fatty acid (7% coronary artery disease reduction at $0.6 per adult) | No intervention | Lifetime | 2765 | ||
| Substitute 2% of energy from trans fat with polyunsaturated fatty acid (40% coronary artery disease reduction at $0.5 per adult) | No intervention | Lifetime | Cost-saving | ||
| Substitute 2% of energy from trans fat with polyunsaturated fatty acid (40% coronary artery disease reduction at $0.6 per adult) | No intervention | Lifetime | 376 | ||
| Reducing salt content by means of legislation+public education | No intervention | Lifetime | 3613 | ||
| Blood pressure-lowering strategies (Rodgers et al 59) | Lifetime | ||||
| Prevention by salt legislation | No intervention | Lifetime | 49 | ||
| Alcohol control strategies (Chisholm et al 15) | |||||
| Taxation current+25% (alcohol use) | No intervention | Lifetime | Cost-saving | ||
| Taxation current+50% (alcohol use) | No intervention | Lifetime | Cost-saving | ||
| Breath testing | No intervention | Lifetime | 152 | ||
| Highest tax+advertisement ban | No intervention | Lifetime | 5002 | ||
| Primary prevention | |||||
| Policy interventions | |||||
| Universal screening for diabetes and hypertension (Dupka et al 73)§ | DALY averted per person | ||||
| Current Package of Essential Non-Communicable (PEN) disease interventions programme | No screening | Lifetime | −77.2 | 0.038 | Cost-saving |
| Universal screening | Current WHO-PEN programme | Lifetime | −33.1 | 0.016 | Cost-saving |
| Screening for GDM to prevent DM (Lohse et al 66) | No intervention | Lifetime | 26 | 2.33 | 16 |
| Screening to prevent GDM (Marseille et al 35) | No intervention | Lifetime | 194 358 | 120 | 2317 |
| Expansion of national insurance to cover primary, secondary and tertiary treatment for CVD (Basu et al 39) | Incremental DALY averted per annum | ||||
| Insurance coverage for primary prevention of CVD | Status quo | 20 years | 1.19 | 2544.5 | 528 |
| Clinical interventions | |||||
| Tobacco control strategies (Jha et al 60) | |||||
| Nicotine replacement therapy effectiveness 1%–5%—low-end estimate | No intervention | Lifetime | 142 | ||
| Nicotine replacement therapy effectiveness 1%–5%—high-end estimate | No intervention | Lifetime | 1880 | ||
| To reduce alcohol use (Chisholm et al 15) | |||||
| Brief physician advice | No intervention | Lifetime | 175 | ||
| CVD prevention strategies (Ortegón et al 29) | Incremental DALYs averted per million population | ||||
| Preventive multidrug treatment (>5% risk of CVD event) | No intervention | Lifetime | 1.97 | 4542 | 4238 |
| Preventive multidrug treatment (>35% risk of CVD event) | Preventive multidrug treatment (>5% risk of CVD event) | Lifetime | 0.38 | 2582 | 341 |
| Combination of individual-based drug therapy for hypertension and cholesterol control | Preventive multidrug treatment (>5% risk of CVD event) | Lifetime | 1.8 | 1780 | 2358 |
| Combined home health education plus trained general practitioner for hypertension management (Jafar et al 36)¶ | No intervention | 2 years | 48 | ||
| Diabetes prevention strategies (Narayan et al 34) | |||||
| Smoking cessation (physician counselling and nicotine replacement therapy) | No intervention | Lifetime | 1990.6 | ||
| Preconception care for women of reproductive age | No intervention | Lifetime | Cost-saving | ||
| Lifestyle interventions to prevent type 2 diabetes | No intervention | Lifetime | 163.6 | ||
| Metformin intervention to prevent type 2 diabetes | No intervention | Lifetime | 4962.9 | ||
| Lifestyle modification+metformin to prevent type 2 diabetes (Ramachandran et al 37) | Number needed to treat to prevent a case of diabetes | ||||
| Lifestyle modification | Standard healthcare advice | 3 years | 164 | 6.4 | 2302 |
| Metformin | Standard healthcare advice | 3 years | 159 | 6.9 | 2396 |
| Lifestyle modification+metformin | Standard healthcare advice | 3 years | 209 | 6.5 | 2973 |
| Secondary and tertiary prevention | |||||
| Policy interventions | |||||
| Policies to expand use of drugs for acute myocardial infarction (Megiddo et al 38) | |||||
| Acute myocardial infarction treatment | |||||
| Aspirin to baseline | No intervention | Lifetime | 0.6 | ||
| Aspirin+injection streptokinase | Aspirin to baseline | Lifetime | 693 | ||
| Acute myocardial infarction prevention | |||||
| Aspirin to baseline | No intervention | Lifetime | 299 | ||
| Aspirin+BB | Aspirin to baseline | Lifetime | 1960 | ||
| Aspirin+BB+ACEi | Aspirin+BB | Lifetime | 3120 | ||
| Polypill to baseline | Aspirin+BB+ACEi+statin | Lifetime | 1904 | ||
| Expansion of national insurance to cover primary, secondary and tertiary treatment for CVD (Basu et al)39 | Incremental DALY averted per annum | ||||
| Insurance coverage for secondary prevention of CVD | Status quo | 20 years | 0.36 | 147.9 | 2708 |
| Insurance coverage for tertiary treatment of CVD | Status quo | 20 years | 4.68 | 2076.8 | 2538 |
| Clinical interventions | |||||
| CVD treatment strategies (Ortegón et al 29) | Incremental DALYs averted per million population | ||||
| Treatment of CHF with diuretics | No intervention | Lifetime | 0.03 | 402 | 188.9 |
| Treatment of CHF with diuretics+exercise training | Treatment of CHF with diuretics | Lifetime | 0.02 | 60 | 776.6 |
| Treatment of CHF with diuretics+exercise training+ACEi | Treatment of CHF with diuretics | Lifetime | 0.04 | 72 | 1296.7 |
| Treatment of CHF with diuretics+exercise training+BB | Treatment of CHF with diuretics | Lifetime | 0.08 | 95 | 1963 |
| Treatment of post-acute ischaemic heart disease and stroke with aspirin, BB, statin | No intervention | Lifetime | 0.03 | 609 | 114 |
| Treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease with aspirin, BB, statin | No intervention | Lifetime | 0.36 | 1047 | 799 |
| Treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease with aspirin, BB, statin, ACEi | Treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease with aspirin, BB, statin | Lifetime | 0.37 | 945 | 914 |
| Treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease and stroke with aspirin, BB, statin | No intervention | Lifetime | 0.04 | 263 | 354 |
| Treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease and stroke with aspirin, BB, statin+CHF (diuretic, exercise) | Treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease and stroke with aspirin, BB, statin | Lifetime | 0.26 | 1879 | 321 |
| Individual-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, statin) | No intervention | Lifetime | 2.57 | 5526 | 1084 |
| Individual-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, ACEi, statin) | Individual-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, statin) | Lifetime | 0.04 | 250 | 373 |
| Individual-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease and stroke (aspirin, BB, statin) | Individual-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, ACEi, statin) | Lifetime | 0.04 | 201 | 464 |
| Individual-based prevention (hypertension and cholesterol control)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretic, exercise) | Individual-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease and stroke (aspirin, BB, statin) | Lifetime | −0.23 | 119 | Cost-saving |
| Individual-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretic, exercise) | Individual-based prevention (hypertension and cholesterol control)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretic, exercise) | Lifetime | 0.26 | 437 | 1387 |
| Combination drug treatment (>25% risk of CVD event)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+treatment of post-acute ischaemic heart disease (aspirin, BB, statin) | No intervention | Lifetime | 1.16 | 4852 | 557 |
| Combination drug treatment (>25% risk of CVD event)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+treatment of post-acute ischaemic heart disease (aspirin, BB, ACEi, statin) | Combination drug treatment (>25% risk of CVD event)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+treatment of post-acute ischaemic heart disease (aspirin, BB, statin) | Lifetime | 0.04 | 237 | 394 |
| Combination drug treatment (>25% risk of CVD event)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin) | Combination drug treatment (>25% risk of CVD event)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+treatment of post-acute ischaemic heart disease (aspirin, BB, ACEi, statin) | Lifetime | 0.04 | 178 | 524 |
| Combination drug treatment (>25% risk of CVD event)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretics, exercise) | Combination drug treatment (>25% risk of CVD event)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin) | Lifetime | −0.23 | 32 | Cost-saving |
| Preventive multidrug treatment for >25% risk of CVD event+multidrug treatment of acute myocardial infarction or post-acute ischaemic heart disease and stroke+diuretics and exercise for CHF | Combination drug treatment (>25% risk of CVD event)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretics, exercise) | Lifetime | 0.26 | 558 | 1086 |
| Combination drug treatment (>35% risk of CVD event)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretics, exercise) | Combination drug treatment (>35% risk of CVD event)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretics, exercise) | Lifetime | −0.23 | 31 | Cost-saving |
| Preventive multidrug treatment for >35% risk of CVD event+multidrug treatment of acute myocardial infarction or post-acute ischaemic heart disease and stroke+diuretics and exercise for CHF | Combination drug treatment (>35% risk of CVD event)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretics, exercise) | Lifetime | 0.26 | 630 | 963 |
| CVD treatment strategies (Murray et al 57) | |||||
| Treatment of SBP above 160 mm Hg with BB and diuretic | No intervention | Lifetime | 103.2 | ||
| Treatment of SBP above 140 mm Hg with BB and diuretic | No intervention | Lifetime | 257.9 | ||
| Treatment with statins for total cholesterol concentrations above education 6.2 mmol/L | No intervention | Lifetime | 134.7 | ||
| Treatment with statins for total cholesterol concentrations above education 5.7 mmol/L | No intervention | Lifetime | 203.5 | ||
| Treatment of SBP above 140 mm Hg with BB and diuretics and with statins for total cholesterol concentrations above 6.2 mmol/L | No intervention | Lifetime | 240.7 | ||
| Multiple drug therapy in >35% CV risk over 10 years | No intervention | Lifetime | Cost-saving | ||
| Multiple drug therapy in >25% CV risk over 10 years | No intervention | Lifetime | 94.6 | ||
| Multiple drug therapy in >15% CV risk over 10 years | No intervention | Lifetime | 137.5 | ||
| Multiple drug therapy in >5% CV risk over 10 years | No intervention | Lifetime | 220.7 | ||
| CVD treatment and secondary prevention (Gaziano et al 43) | |||||
| Medical therapy for acute myocardial infarction with aspirin | No intervention | Lifetime | 25.8 | ||
| Medical therapy for acute myocardial infarction with aspirin+BB | No intervention | Lifetime | 31.5 | ||
| Medical therapy for acute myocardial infarction with aspirin+BB+streptokinase | No intervention | Lifetime | 1828.8 | ||
| Medical therapy (aspirin+BB) for ischaemic heart disease, having hospital access | No intervention | Lifetime | Cost-saving | ||
| Medical therapy (aspirin+BB+ACEi) for ischaemic heart disease, having hospital access | No intervention | Lifetime | 2049.5 | ||
| Medical therapy (aspirin+BB+ACEi+statin) for ischaemic heart disease, having hospital access | No intervention | Lifetime | 5214.2 | ||
| Medical therapy (aspirin+BB) for ischaemic heart disease, limited hospital access | No intervention | Lifetime | 1106.4 | ||
| Medical therapy (aspirin+BB+ACEi) for ischaemic heart disease, limited hospital access | No intervention | Lifetime | 2373.4 | ||
| ACEi for CHF, hospital access | Baseline of diuretics | Lifetime | Cost-saving | ||
| ACEi, BB (metoprolol) for CHF, hospital access | Baseline of diuretics | Lifetime | 627.7 | ||
| ACEi for CHF, limited hospital access | Baseline of diuretics | Lifetime | 71.6 | ||
| ACEi, BB (metoprolol) for CHF, limited hospital access | Baseline of diuretics | Lifetime | 782.5 | ||
| Blood pressure-lowering strategies (Rodgers et al 59) | |||||
| Multidrug regimen (aspirin, a BB, a thiazide diuretic, an ACEi and a statin) in 35% CV risk over 10 years | No intervention | Lifetime | 1827 | ||
| Multidrug regimen (aspirin, a BB, a thiazide diuretic, an ACEi and a statin) in 25% CV risk over 10 years | No intervention | Lifetime | 3408.6 | ||
| Multidrug regimen (aspirin, a BB, a thiazide diuretic, an ACEi and a statin) in 15% CV risk over 10 years | No intervention | Lifetime | 5268.2 | ||
| Treat-to-target, benefit-based tailored treatment strategy vs hybrid strategy for lowering CVD risk (Basu et al 78) | |||||
| People treated identically by all three strategies | No intervention | 10 years | 383.7 | ||
| People treated most intensively by treat-to-target | No intervention | 10 years | 432.1 | ||
| People treated most intensively by benefit-based tailored treatment | No intervention | 10 years | 206.1 | ||
| People treated most intensively by hybrid | No intervention | 10 years | 384.4 | ||
| Prehospital ECG for accurate referral and timely access to reperfusion (Schulman-Marcus et al 40) | No ECG-based referral in case of chest pain | Lifetime | 0.15 | 0.012 (QALY gained) | 26.1 |
| Diabetes treatment strategies (Narayan et al 34) | Lifetime | ||||
| Glycaemic control in people with HbA1c >9% (insulin, oral glucose-lowering agents, diet and exercise) | No intervention | Lifetime | Cost-saving | ||
| Blood pressure control in people with >160/95 mm Hg | No intervention | Lifetime | Cost-saving | ||
| Foot care in people with a high risk of ulcers | No intervention | Lifetime | Cost-saving | ||
| Influenza vaccination among elderly | No intervention | Lifetime | 490.8 | ||
| Annual eye examination | No intervention | Lifetime | 954.4 | ||
| ACEi use for people with diabetes | No intervention | Lifetime | 1390.7 | ||
| Intensive glucose control for people with HbA1c >8% (insulin, oral glucose-lowering agents or both) | No intervention | Lifetime | 5453.7 | ||
| Treatment of diabetes and its complications (Ortegón et al 29) | Incremental DALYs averted per million population | ||||
| Standard glycaemic control | No intervention | Lifetime | 0.82 | 1717 | 1115 |
| Retinopathy screening and photocoagulation therapy | No intervention | Lifetime | 0.32 | 1891 | 396.4 |
| Standard glycaemic control+retinopathy screening+neuropathy screening | Intensive glycaemic control+neuropathy screening | Lifetime | −0.65 | 213 | Cost-saving |
| BIAsp 30±oral glucose-lowering drugs (Gupta et al 41) | Incremental QALY gained per annum | ||||
| BIAsp 30 | BHI 30 or IGlar | 30 years | 868.496 | 2.52 | 412.9 |
| BIAsp 30 | NPH insulin | 30 years | −2524.192 | 2.82 | Cost-saving |
| BIAsp 30 | IGlar | 30 years | 527.232 | 2.74 | 228.8 |
| BIAsp 30 | BHI 30 or IGlar | 1 year | 123.264 | 0.21 | 684.2 |
| BIAsp 30 | IGlar | 1 year | 93.984 | 0.23 | 487.2 |
| Basal insulin vs oral glucose-lowering drugs (Home et al 75) | Incremental QALY gained per annum | ||||
| Basal insulin treatment with insulin detemir | Oral glucose-lowering drugs | 30 years | 3510.36 | 4.97 | 834.1 |
| Basal insulin treatment with insulin detemir | Oral glucose-lowering drugs | 1 year | 338.796 | 0.322 | 1243.4 |
| Telemedicine screening+diabetic retinopathy treatment (Rachapelle et al 27) | |||||
| Health system perspective | Incremental QALY gained per annum | ||||
| Screening once in a lifetime | No screening | 25 years | 6.5 | 0.0049 | 2214.1 |
| Screening twice in a lifetime | No screening | 25 years | 5.3 | 0.0039 | 2252.7 |
| Screening every 5 years | No screening | 25 years | 19.6 | 0.0097 | 3400.1 |
| Screening every 3 years | No screening | 25 years | 17.4 | 0.0084 | 3411.8 |
| Screening every 2 years | No screening | 25 years | 18.4 | 0.0075 | 4084.5 |
| Societal perspective | |||||
| Screening once in a lifetime | No screening | 25 years | 13.2 | 0.0049 | 4515.6 |
| Screening twice in a lifetime | No screening | 25 years | 9.7 | 0.0039 | 4151.6 |
| Screening every 5 years | No screening | 25 years | 30.3 | 0.0097 | 5257 |
| Combination of primordial, primary, secondary and tertiary prevention | |||||
| Interventions to reduce hazardous alcohol use (Chisholm et al 15) | |||||
| Highest tax+advertisement ban+brief advice | No intervention | Lifetime | 2562.7 | ||
| Blood pressure-lowering strategies (Rodgers et al 59) | |||||
| Prevention by salt legislation+health education | No intervention | Lifetime | 87.2 | ||
| Treatment with aspirin, BB, and a statin+salt legislation+health education in 35% CV risk over 10 years | No intervention | Lifetime | 362.6 | ||
| Treatment with aspirin, BB, and a statin+salt legislation+health education in 25% CV risk over 10 years | No intervention | Lifetime | 1576 | ||
| Treatment with aspirin, BB, and a statin+salt legislation+health education in 15% CV risk over 10 year | No intervention | Lifetime | 3054 | ||
| Intervention for CVD prevention and treatment (Murray et al 57) | |||||
| Combination of legislation for salt reduction, health education and treatment of individuals with combined CV risk of 35% with statin, diuretic, BB and aspirin | No intervention | Lifetime | 63 | ||
| Combination of legislation for salt reduction, health education and treatment of individuals with combined CV risk of 25% with statin, diuretic, BB and aspirin | No intervention | Lifetime | 89 | ||
| Combination of legislation for salt reduction, health education and treatment of individuals with combined CV risk of 15% with statin, diuretic, BB and aspirin | No intervention | Lifetime | 132 | ||
| Combination of legislation for salt reduction, health education and treatment of individuals with combined CV risk of 5% with statin, diuretic, BB and aspirin | No intervention | Lifetime | 212 | ||
| CVD prevention and treatment strategies (Ortegón et al 29) | Incremental DALYs averted per million population | ||||
| Population-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, statin) | No intervention | Lifetime | 0.55 | 2376 | 538 |
| Population-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, ACEi, statin) | Population-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, statin) | Lifetime | 0.04 | 285 | 326 |
| Population-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease and stroke (aspirin, BB, statin) | Population-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute ischaemic heart disease (aspirin, BB, ACEi, statin) | Lifetime | 0.04 | 246 | 380 |
| Population-based prevention (hypertension and cholesterol control)+treatment of acute myocardial infarction (aspirin, BB, ACEi, streptokinase)+post-acute Ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretic, exercise) | Population-based prevention (hypertension and cholesterol control)+treatment of post-acute ischaemic heart disease and stroke (aspirin, BB, statin)+CHF (diuretic, exercise) | Lifetime | 0.26 | 646 | 937 |
| Expansion of national insurance to cover primary, secondary and tertiary treatment for CVD (Basu et al)39 | Incremental DALY averted per annum | ||||
| Insurance coverage for primary+secondary prevention of CVD | Primary prevention only | 20 years | 0.35 | 145.0 | 2739 |
| Insurance coverage for primary+tertiary prevention of CVD | Primary prevention only | 20 years | 4.67 | 2084.6 | 2525 |
GDP per capita (US$, 2016) for India, Pakistan and Bhutan are 1861.5, 1468.2 and 729.5, respectively.
*Values refer to original study period.
†Conversion to current year, based on midyear consumer price index inflation rates.
‡Non-price interventions to reduce tobacco use:
–protection from exposure to tobacco smoke
–regulation of the contents of tobacco products
–regulation of tobacco product disclosures
–packaging and labelling of tobacco products
–education, communication, training and public awareness
–tobacco advertising, promotion and sponsorship
–demand reduction measures concerning tobacco dependence and cessation.
§Conducted in Bhutan.
¶Conducted in Pakistan.
ACEi, ACE inhibitors; BB, beta-blockers (blood pressure-lowering agents; BHI, biphasic human insulin; BIAsp 30, biphasic insulin aspart 30; CHF, congestive heart failure; CV, cardiovascular; CVD, cardiovascular diseases; DALY, disability-adjusted life years; DM, diabetes mellitus; GDM, gestation diabetes mellitus; GDP, gross domestic product; HbA1c, glycated haemoglobin; ICER, incremental cost-effectiveness ratio; IGlar, insulin glargine; QALY, quality-adjusted life years; NPH, neutral protamine Hagedorn; SBP, systolic blood pressure.